Exploring the Brain: A Book Review of the Tale of the Dueling Neurosurgeons

A concussed king, a blind man who explored the world through echolocation, men who suffered cramps in limbs amputated years ago, confabulators, cannibals consumed by a laughing disease, mad assassins, and people who insist they are dead. And those are just the patients. The scientists who have studied such neurological curiosities are in some ways even more fascinating characters than their patients. In his new book, The Tale of the Dueling Neurosurgeons: The History of the Human Brain as Revealed by True Stories of Trauma, Madness, and Recovery, author Sam Kean skillfully intertwines the stories of doctors and their patients into a history of neuroscience that is as fascinating as it is bizarre.

Experimental science exists to understand those phenomena that cannot be directly observed. Put simply, the scientific method involves changing one thing about a system and then observing the ramifications. However, things are a bit more complicated in the study of the human brain. For one, the field of neuroscience is relatively young because the brain was long considered sacred, out of the reach of science. Secondly, it is widely considered unethical to experiment on the brains of living people. As a result, neuroscience adopted the method of waiting for some sort of damage to the brain to occur naturally and then examining the result. Although this might sound like a crude approach to science, most of what we know about the human brain has been discovered in just this way. We have also studied brain function in animal models and more recently fMRI scanning has allowed us to examine the activity of living brains. However, animal models present obvious limitations for understanding the complex human brain and fMRI technology is still in its infancy. Therefore, in many cases, we can only understand our own brains indirectly, by observing individual cases of “trauma, madness, and recovery”. In Dueling Neurosurgeons, Kean traces the development of our knowledge of the human brain through many such illuminating cases.

“The world would have looked stunningly, alarmingly bright to the king of France, then suddenly dark” (19). In the titular story of Dueling Neurosurgeons, the unlikely King Henri II of France holds a jousting tournament to celebrate two marriages that had brought peace to Europe. Henri himself participated in the jousting, and after two good runs, he decided to go for a third, against a young Scot named Montgomery. This time though, the king almost fell off his horse. Embarrassed, Henri insisted on jousting again, breaking any number of traditions and laws of chivalry. When the men met again, the blow was forceful and both lances shattered. In a freak accident, however, the splintered end of Montgomery’s lance rebounded, striking the king forcefully in the eye and causing the king to suffer a massive concussion. “Over the next eleven days… most of the great themes of the next four centuries of neuroscience would play themselves out in the microcosm of his brain” (19). The king’s eyesight suffered, a clue that pointed to the localization of brain function and specifically the presence of a visual center at the back of the brain where Henri’s brain was damaged. He also experienced seizures and paralysis on only one side of the body, indicating that the halves of the brain control different halves of the body. Finally, his brain expanded, worsening his headache while the increasing pressure slowly crushed his neurons and finally killed him as well, indicating that brain trauma can be fatal even without skull injury. Of course, the neuroscientists knew none of this at the time, but the progress of Henri’s illness foreshadowed discoveries to come in the future.

Prior to his death however, the story of King Henri’s unsuccessful treatment played out somewhat like a bizarre historical soap opera. Along the way, the king was fed a potion including charred Egyptian mummy, the queen ordered the decapitation of four criminals so that the doctors could replicate Henri’s injury on their severed heads, and in the end, the king succumbed to his injuries, allowing Catherine, an Italian, to seize control of France. This might seem to be simply an obscure and entertaining story, but as Kean demonstrates, the death of King Henri also proved a turning point for neuroscience. The king’s subsequent autopsy set a new standard for doctors all over Europe, and autopsies became widespread. In cases of brain damage and trauma, these autopsies caused a boom in knowledge of the human brain, allowing doctors to correlate damage to symptoms and begin to map out the gross anatomy of the human brain in a way never before believed possible.

The story of Andreas Vesalius, one of the neurosurgeons who treated Henri, could rival even those of the strangest neurological curiosities contained in Dueling Neurosurgeons. As a teenager, Vesalius would sneak outside the city walls of Flanders at night to rob graves and steal corpses from gallows before sneaking back to perform obsessive autopsies—despite the strong cultural taboo against human dissection. The young Vesalius found a strange delight in the tactile experience of the human body and delighted in probing and squeezing the organs. He eventually went on to medical school, where he was taught the theory of anatomy straight out of the work of the revered Roman physician Galen. He realized, however, that what he was being taught didn’t fit with his observations from real human corpses. Vesalius had a hard time accepting that Galen could be wrong (amusingly, he postulated that anatomy might have changed since Roman times because men wore pants instead of togas), but he eventually had to admit that Galen had made quite a few logical leaps from studying the anatomies of other animals. To right these wrongs, Vesalius wrote his masterpiece, De Humani Corporis Fabrica or “On the Fabric of the Human Body”. Not happy to stop there, he sought out the great artist Titian and his apprentices to create amazingly realistic illustrations for his book. “Unlike in modern textbooks, the bodies in Fabrica don’t lie flat and lifeless on a table. They rise and strut and pose like classical statues. Some do a veritable striptease with their flesh, peeling back layer after layer to reveal their inner organs and organic essence” (30). This book revolutionized many fields of science. Crucially for the field of neuroscience, Vesalius revealed that past conceptions of the structure of the human brain were based on dissections by Galen of cow brains, different in structure and far less complex than our own. Now neuroscientists could actually study the human brain with a proper understanding of its structure.

Dueling Neurosurgeons is divided into five parts, each of which serves to teach the reader about some element of neuroscience, all the way from “Gross Anatomy” to “Consciousness”. Within each of these sections, Kean shares a series of entertaining anecdotes, much like the stories of Henri II and Vesalius, which reveal both the workings of the human brain and how they were discovered. Kean’s writing is rich, detailed, and captivating. We can just imagine the shock of William Sharpe, vividly described by Kean, when Harvey Cushing dispatched him, on his first day as a medical resident, to a funeral home to bribe a priest and retrieve the endocrine glands and major organs of a deceased giant. Kean brings history to life, giving the reader insight into men like Ambroise Paré, a lowly barber-surgeon who discovered by accident that a paste of his own creation (the recipe at one point included earthworms and dead puppies) worked better than boiling oil for cauterizing bullet wounds, and Carleton Gajdusek, who trekked through the uninviting highlands of New Guinea inhabited by cannibalistic tribes in an attempt to discover the source of the devastating “laughing disease”.

Through these stories and others, Kean makes neuroscience engaging to even the most apathetic reader. He covers the old standards of neuroscience case studies, including the well-known Phineas Gage, the man who survived his own tamping rod traveling through his brain, and H.M., the “unforgettable” amnesiac with no long-term memory. Kean goes far beyond these well-worn stories, however, digging up the strangest and most fascinating cases from the history of neuroscience to delight and engage the reader. Along the way, he also manages to teach the reader a great deal about the human brain. This is popular science, so Dueling Neurosurgeons assumes no previous knowledge and covers only basic neuroscience. However, it is well worth a read even for those very familiar with the material covered. More than the science itself, the human element of neuroscience is truly the focus of Dueling Neurosurgeons. Kean steers clear of dry technical descriptions of the brain, preferring a portrayal of the human brain that focuses fittingly on the human aspects. Ultimately, Dueling Neurosurgeons is about the amazing resilience of the human brain in the face of trauma and about those who have worked to expand our knowledge of this precious and complex organ.

References

Kean, Sam. The Tale of the Dueling Neurosurgeons: The History of the Human Brain as Revealed by True Stories of Trauma, Madness, and Recovery. New York: Little, Brown and Company, 2014. Print.